Do You Need an X-ray for Low Back Pain?

Patients who suffer from low back pain often feel frustrated when the cause of the pain is unclear, as is often the case. Sometimes people think that the more tests they have, the closer they will get to understanding the problem. However, X-rays for low back pain--a commonly prescribed diagnostic test--have a poor record of helping doctors figure out what's wrong. If that's the case, why are X-rays so commonly prescribed for this condition?

A recent study conducted in Norway suggests that patients who are given adequate information and support may be less likely to want unnecessary tests. In the study, 99 patients who received X-rays for low back pain were interviewed afterward. They ranged in age from 14 to 91 years old. They were asked to rate the importance of having an X-ray for their back pain. They were also asked about their views on the usefulness of and reasons for the X-rays. Other information was collected on the patients' condition.

Seventy-two percent of patients in the study said X-rays were very important for their condition. Men were more likely to think that X-rays were important than women. Those with worsening symptoms were more likely to think that, too. Interestingly, those who had the least real need for X-rays according to medical criteria were also more likely to think the X-rays important. This led researchers to believe that some patients may need more information or support from their doctors.

X-Ray Twisting Your Arm? Here's Why

You just had an X-ray taken of a very painful wrist. The X-ray technician comes back and tells you that one more view is required. This time you have to turn your hand and forearm in the very position that hurts the most. Is this really necessary?

Actually, doctors who read X-rays (radiologists) are asking the same question. Radiologists have studied cadavers (human bodies preserved for study) to determine correct positions for X-rays. From these studies, doctors decided that one X-ray of the wrist had to be done with the hand in a neutral position. The shoulder and elbow had to be in specific positions as well.

X-rays of the wrist are often taken with the forearm slightly rotated. This places the hand in a palm down position. When this happens by mistake, a second X-ray is needed. In the next X-ray, the wrist and forearm must be in a neutral position--or so say cadaver studies.

These researchers decided to conduct X-ray studies on human volunteers to see whether the cadaver findings hold true in live arms. The researchers thought there would be a difference in the position of bones in a live arm because of muscle forces. A study of 15 healthy adults was done to find out how important slight differences in hand placement might be. X-rays were taken of the wrist in three different positions. The space difference between the ends of two forearm bones in the wrist was measured.

The results were a bit tricky to interpret. The difference in the position of the bones was considered significant in research terms. However, the researchers pointed out that a statistical difference isn't necessarily an important difference in the clinical setting. Getting another X-ray with the forearm and wrist in a neutral position may not be necessary after all.

Results for "normal" subjects might not be the same as those for patients with wrist problems. Maybe the bones would move differently if the person was in pain or unable to move easily. Age or sex may also mak...

X-rays No Longer Needed to Guide Nerve Blocks

Improvements in technology continue to change the way medicine is practiced. In this study from Japan, physicians used ultrasound instead of X-rays to guide a needle in performing a nerve block. The procedure was effective for 75 of the 78 patients in the study. And the method proved to be safe as no one felt pain during the procedure or had any negative effects from the treatment.

Switching from using X-rays to ultrasound when doing nerve blocks is possible now that today’s ultrasound machines produce high quality images. And the devices are small enough to be portable making the procedure available in a clinic rather than in the radiology department. Best of all, both patients and medical staff are no longer exposed to so much radiation from the previously used X-ray technique.

Nerve blocks are used for patients with chronic pain. In this study, the patients had a L5 radicular syndrome. L5 is the fifth lumbar segment of the lumbar spine (low back). Radicular tells us that the spinal nerve root that exits from the spinal cord at that level is compressed or irritated. This compromise of the nerve tissue sends pain from the back into the buttock and possibly down the leg.

The cause of the syndrome can be from a herniated disc, spinal stenosis, or spondylolisthesis. Most people know what a herniated disc is but spinal stenosis and spondylolisthesis may not be as familiar. Stenosis refers to a narrowing of the spinal canal where the spinal cord is located. Spondylolisthesis is the slippage of a vertebral body forward over the segment below it. This change in the spinal alignment can put a traction (pulling) or compressive (pinching) force on the spinal cord in the spinal canal and/or spinal nerve roots as they leave the spinal canal.

Pain messages are sent when there is pressure on the nerve tissue from any of these conditions. Applying electrical stimulation to the nerve identifies correct placement of the needle used to inject a numbing agent to stop pain signals from traveling up the spinal cord to the brain. The patient feels a tapping sensation that is not painful when the probe delivers an electrical stimulus around the nerve root. The probe is slowly pushed through the skin and soft tissues entering the spine near the L5 nerve root. At the same time, the multibeam ultrasound unit transmits pictures to a TV or computer monitor to guide the physician's forward advancement of the probe to the correct spot.

By using this ultrasound technique, the patient is spared the intense pain that accompanies the X-ray guided technique. With the X-ray technique, a dye is injected into the nerve (under the outer layer of the nerve) to help identify the exact location of the nerve and placement of the numbing agent. When the nerve is injected with the dye, the nerve endings register pain that is intense. Using an electrical probe eliminates the need to touch the nerve. The researchers also found that placing the injected numbing age...

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